作者：沈炀1，贺彬婵1，周茜1，董高军1，徐小勇1，刘克琴1，陈菲2，殷立平1

单位：

1.210000江苏省南京市，南京中医药大学第二附属医院 江苏省第二中医院　 2.210003江苏省南京市，南京中医药大学附属南京医院 南京市第二医院

Units：

1.The Second Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Second Hospital of Traditional ChineseMedicine, Nanjing 210000, China 2.Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine/the Second Hospital of Nanjing, Nanjing210003, China

关键词：

新型冠状病毒肺炎；高血压；中年；老年人；临床特征

Keywords：

COVID-19; Hypertension; Middle age; Aged; Clinical feature

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.159

Funds：

国家自然科学基金青年科学基金项目（82100088）

摘要：

目的　探讨中老年高血压并非重型新型冠状病毒肺炎（COVID-19）患者的临床特征。方法　回顾性选取2021-07-22至2021-09-03南京市公共卫生中心收治的中老年非重型COVID-19患者97例。根据入院诊断将患者分为高血压组（46例）与非高血压组（51例）。通过电子病历系统收集患者一般资料、临床表现及发病6、12、18、24 d心肌指标。采用一元线性回归分析和多元线性回归分析探讨中老年非重型COVID-19患者病程的影响因素。结果　高血压组患者病程长于非高血压组（P ＜0.05）。两组临床表现比较，差异无统计学意义（P ＞0.05）。组别与时间在心肌肌钙蛋白I（cTnI）、α-羟丁酸脱氢酶（α-HBDH）上不存在交互作用（P ＞0.05），组别与时间在乳酸脱氢酶（LDH）上存在交互作用（P ＜0.05）；组别在cTnI、α-HBDH、LDH上主效应显著（P ＜0.05）；时间在cTnI、α-HBDH、LDH上主效应显著（P ＜0.05）。高血压组患者发病6、12、18、24 d cTnI高于非高血压组，发病12、18 dα-HBDH高于非高血压组，发病12 d LDH高于非高血压组（P ＜0.05）。非高血压组患者发病24 d cTnI、α-HBDH、LDH低于发病6、12 d，发病18 d α-HBDH低于发病12 d（P ＜0.05）；高血压组患者发病24 d LDH低于发病6 d，发病12 d α-HBDH、LDH高于发病6、18、24 d，发病24 d cTnI低于发病12 d，发病24 d α-HBDH、LDH低于发病18 d（P ＜0.05）。多元线性回归分析结果显示，高血压、BMI、临床分型、肺部影像学改变是中老年非重型COVID-19患者病程的影响因素（P ＜0.05）。结论　中老年高血压并非重型COVID-19患者病程较未合并高血压的COVID-19患者长，且心肌损伤更严重；合并高血压、BMI升高、临床分型为普通型、发生肺部影像学改变是中老年非重型COVID-19患者病程延长的危险因素。

Abstract：

Objective　To explore the clinical characteristics of middle-aged and elderly patients with hypertension and non-severe corona virus disease 2019 (COVID-19) .Methods　A total of 97 middle-aged and elderly non-severe COVID-19 patients admitted to Nanjing Public Health Center from 2021-07-22 to 2021-09-03 were retrospectively selected.According to the admission diagnosis, the patients were divided into hypertensive group (46 cases) and non-hypertensive group (51 cases) . The general information, clinical manifestations and myocardial indexes of the patients at 6, 12, 18, and 24 days of onset were collected through the electronic medical record system. Univariate linear regression analysis and multiple linear regression analysis were used to explore the influencing factors of disease course in middle-aged and elderly non-severe COVID-19patients.Results　The course of disease in the hypertensive group was longer than that in the non-hypertensive group (P < 0.05) .There was no significant difference in clinical manifestations between the two groups (P > 0.05) . There was no interaction between groups and time on cardiac troponin I (cTnI) , α-hydroxybutyrate dehydrogenase (α-HBDH) (P > 0.05) , there was an interaction between group and time on lactate dehydrogenase (LDH) (P < 0.05) ; the main effect of group was significant on cTnI, α-HBDH, LDH was significant (P < 0.05) ; the main effect of time was significant on cTnI, α-HBDH and LDH (P < 0.05) . The hypertensivegroup had higher cTnI at 6, 12, 18, and 24 days of onset than the non-hypertensive group, higher α-HBDH at 12, and 18 days of onset than the non-hypertensive group, and higher LDH at 12 days of onset than the non-hypertensive group (P < 0.05) . In the non-hypertensive group, the cTnI, α-HBDH and LDH at 24 days of onset were lower than those at 6 and 12 days of onset, andthe α-HBDH at 18 days of onset was lower than that at 12 days of onset (P < 0.05) ; in the hypertension group, the LDH at 24 daysof onset was lower than on 6 days of onset, the α-HBDH and LDH at 12 days of onset were higher than those at 6, 18 and 24 days ofonset, the cTnI at 24 days of onset was lower than that at 12 days of onset, and the α-HBDH and LDH at 24 days of onset were lowerthan those at 18 days of onset (P < 0.05) . Multiple linear regression analysis showed that hypertension, BMI, clinical classificationand pulmonary imaging changes were the influencing factors of the course of disease in middle-aged and elderly patients withnon-severe COVID-19 (P < 0.05) .Conclusion　The course of middle-aged and elderly hypertensive patients with non-severeCOVID-19 is longer than that in COVID-19 patients without hypertension, and the myocardial injury is more serious. The risk factorsof prolonging the course of disease in middle-aged and elderly patients with non severe COVID-19 are hypertension, increased BMI,common clinical classification and pulmonary imaging changes.

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